Mich. Admin. Code R. 418.10212 - Physical and occupational therapy; physical medicine services ; physical treatment
Rule 212.
(1) For
the purposes of workers' compensation, physical medicine services, procedure
codes 97010-97799, shall be referred to as "physical treatment" when the
services are provided by a practitioner other than a physical therapist or an
occupational therapist. Physical therapy means physical treatment provided by a
licensed physical therapist. Occupational therapy means physical treatment
provided by an occupational therapist.
(2) Physical medicine services shall be
restorative. If documentation does not support the restorative nature of the
treatment, then the service shall not be reimbursed.
(3) Any of the following may provide physical
treatment, to the extent that licensure, registration, or certification law
allows:
(a) A doctor of medicine.
(b) A doctor of osteopathic medicine and
surgery.
(c) A doctor of dental
surgery.
(d) A doctor of
chiropractic.
(e) A doctor of
podiatric medicine and surgery.
(f)
A physical therapist.
(g) An
occupational therapist.
(4) Only a licensed physical therapist,
licensed occupational therapist, or licensed practitioner may use procedure
codes 97161-97168 to describe the physical medicine and rehabilitation
evaluation services. Job-site evaluations may be paid to a licensed
occupational therapist, a licensed physical therapist, or a physician. Job-site
evaluations for workers' compensation are by report and are described on the
bill using codes WC500-WC600.
(5)
If a practitioner performs and bills for physical treatment, then the
practitioner shall do all of the following:
(a) Perform an initial evaluation.
(b) Develop a treatment plan.
(c) Modify the treatment as
necessary.
(d) Perfor m a discharge
evaluation. The practitioner shall provide the carrier with an initial
evaluation and a progress report every 30 calendar days and at discharge.
Documentation requirements are the same as the requirements in
R
418.10204(2).
(6) A provider shall report procedure code
97750 to describe a functional capacity evaluation. The carrier shall reimburse
a maximum of 24 units or 6 hours for the initial evaluation. Not more than 4
additional units shall be billed for a re-evaluation occurring within 2
months.
(7) Physical medicine
modalities are those agents applied to produce therapeutic changes to tissue
and include, but are not limited to, thermal, acoustic, light, mechanical, or
electric energy. Both of the following apply:
(a) Supervised modalities include procedure
codes 97010-97028. These codes do not require direct 1-on-1 patient contact by
the provider. These modalities shall be performed in conjunction with a
therapeutic procedure including manipulative services or the modalities shall
not be reimbursed.
(b) Constant
attendance modalities are those procedure codes 97032-97039 that require direct
1-on-1 patient contact by the provider.
(8) Therapeutic procedure codes 97110-97546
are procedures that effect change through the application of clinical skills
and services that attempt to improve function. The physician or therapist shall
have direct 1-on-1 patient contact.
(9) The following provisions apply to the
listed modality services:
(a) Whirlpool shall
only be reimbursed when done for debridement or as part of a restorative
physical treatment program.
(b)
Procedure 97010 is a bundled procedure code and shall not be reimbursed
separately.
(c) Not more than 1
deep heat procedure shall be billed on the same date of service for the same
diagnosis. Deep heat procedures include diathermy, microwave, ultrasound, and
phonophoresis.
(d) Phonophoresis
shall be billed using procedure code 97035 with modifier code -22 and shall be
reimbursed at the same rate as procedure code 97035, plus $2.00 for the active
ingredient used in the process.
(e)
Iontophoresis shall include the solution, medication, and the
electrodes.
(f) Electrical
stimulation shall include the electrodes.
(g) Procedure codes 97032, 97033, and 97035
shall not be reimbursed to a doctor of chiropractic.
(h) Fluidotherapy, a dry whirlpool treatment,
shall be reported using code 97022.
Notes
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